International Braz J Urol最新文献

{"title":"Pain Perception During Transperineal and Transrectal Prostate Biopsy Under Local An-esthesia: a Prospective Analysis of a Multi-ethnic and Diverse Cohort.","authors":"Kevin Joseph Chua, Lorenzo Storino Ramacciotti, Masatomo Kaneko, Yuta Inoue, Luis Medina Navarro, Jie Cai, Manju Aron, Pierre Halteh, Eric Kau, Anne Schuckman, Sij Hemal, Mihir Desai, Hooman Djaladat, Inderbir S Gill, Monish Aron, Andre Luis Abreu","doi":"10.1590/S1677-5538.IBJU.2025.0512","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0512","url":null,"abstract":"<p><strong>Purpose: </strong>To assess factors associated with patients' self-assessed pain scores during prostate biopsy (PBx) performed exclusively under local anesthesia (LA).</p><p><strong>Materials and methods: </strong>Consecutive patients who underwent MRI followed by a transperineal (TP) or transrectal (TR) PBx under LA were prospectively assessed. Race and ethnicity were self-reported according to NIH standards. Socioeconomic status was assessed using the Distressed Community Index (DCI). Pain was evaluated with a visual analog scale (0-10) after the procedure. Univariable and multivariable linear regression analyses were performed to correlate clinical parameters related to pain.</p><p><strong>Results: </strong>A total of 419 patients underwent TP (77%) or TR (23%) PBx. Overall, 14% of patients were Asian, 5% Black, 17% Latino, 12% Others, and 53% White. Of the cohort, 20% of Black and 27% of Latino patients were most distressed (DCI 80-100) compared with 4% of Asian, 9% of Other, and 5% of White patients (p<0.001). The median (IQR) self-assessed pain levels were higher for Black 5 (2-5) and Latino 4 (3-5) compared to Asian 3 (2-4), Other 3 (2-5), and White 3 (2-4) patients (p=0.01). On multivariable analysis, younger patients, Black or Latino patients, and the number of lesions on MRI were independent predictors for pain levels.</p><p><strong>Conclusions: </strong>PBx under LA alone are generally well tolerated; however, there is a subset of patients who experience more pain, including Black and Latino, younger patients, and those with more MRI suspicious lesions. Discussion of these pain risk factors is important for patients when choosing to have a biopsy performed under LA versus sedation.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146183054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gonadotropin Stimulation Before Sperm Retrieval in Non-Obstructive Azoospermia: Myth, Magic, or Medicine?","authors":"Marina C Viana, Arnold P P Achermann, Danilo L Andrade, Ricardo Miyaoka, Sandro C Esteves","doi":"10.1590/S1677-5538.IBJU.2026.9902","DOIUrl":"10.1590/S1677-5538.IBJU.2026.9902","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is there still a role for systematic biopsy after targeted biopsy for the detection of clini-cally significant prostate cancer in MRI suspicious lesions?","authors":"João M Pina, João Guerra, Miguel B Lança, João L Dias, Rita N Lucas, Luis C Pinheiro","doi":"10.1590/S1677-5538.IBJU.2025.0653","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0653","url":null,"abstract":"<p><strong>Purpose: </strong>The combination of systematic biopsy (SB) and MRI-targeted biopsy (TB) is the current approach for prostate cancer (PCa) diagnosis; however, the clinical benefit of including SB remains controversial. This study aimed to determine whether SB adds value beyond TB in detecting clinically significant prostate cancer (csPCa) in men with suspicious lesions.</p><p><strong>Materials and methods: </strong>Retrospective, single-center study conducted between January 2019 and September 2023. It enrolled men with suspicious lesions identified on multiparametric MRI (PI-RADS≥3) who had undergone combined biopsy (TB+SB). Sociodemographic and clinical data were secondarily collected. csPCa was defined when ISUP≥2.</p><p><strong>Results: </strong>This study included 997 men with a median age of 68 years, of whom 497 had a negative prior biopsy. The TB+SB approach identified 53.0% of PCa and 36.8% of csPCa cases. TB alone significantly outperformed SB in identifying csPCa, with detection rates of 34.8% vs. 10.3%, respectively, missing only 4.8% of PCa diagnosis-most of which were low-grade tumors. SB contributed marginally, identifying additional csPCa cases in 1.4% of patients. In patients with a prior negative biopsy, the addition of SB to TB only accounted for 12.5% of PCa diagnosis. Limitations include the study single-center design, restricting generalizability, and the lack of whole-mount prostatectomy for histological confirmation.</p><p><strong>Conclusions: </strong>In conclusion, SB adds limited diagnostic value, with TB alone being sufficient for detecting csPCa cases in patients with MRI-visible lesions. The results suggest that SB may be safely omitted in selected patients to reduce biopsy burden and lead to better clinical outcomes.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prostate Biopsy Once Again Is a Hot Topic in This Issue of the International Brazilian Journal of Urology.","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2026.03.01","DOIUrl":"10.1590/S1677-5538.IBJU.2026.03.01","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial Comment: Maximal anatomic bladder neck preservation at the prostatic origin (MANO) in robotic radical prostatectomy: does prostate size matter?","authors":"Luciano A Favorito","doi":"10.1590/S1677-5538.IBJU.2026.9904","DOIUrl":"10.1590/S1677-5538.IBJU.2026.9904","url":null,"abstract":"","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The WHO 2025 Guideline for the Prevention, Diagnosis and Treatment of Infertility: A Comprehensive Review with Focus on Male Reproductive Health.","authors":"Sandro C Esteves","doi":"10.1590/S1677-5538.IBJU.2026.0121","DOIUrl":"10.1590/S1677-5538.IBJU.2026.0121","url":null,"abstract":"<p><p>Infertility affects millions worldwide and is increasingly recognized as a major public-health concern. Despite advances in reproductive medicine, the lack of a unified global framework has contributed to substantial heterogeneity in clinical practice, particularly in the evaluation and management of male infertility. In 2025, the World Health Organization (WHO) issued its first comprehensive Guideline for the Prevention, Diagnosis, and Treatment of Infertility, establishing a global, evidence-based standard applicable across diverse resource settings. Notably, the guideline integrates male reproductive health throughout prevention, diagnosis, and treatment pathways, reinforcing the essential role of paternal factors in reproductive outcomes. This review summarizes the development, scope, and methodological foundations of the WHO guideline, including its use of systematic evidence synthesis, the GRADE framework, and structured consensus processes. Particular emphasis is placed on male-focused recommendations and good practice statements on lifestyle risk modification, sexually transmitted infections, standardized semen analysis, diagnostic algorithms, unexplained infertility, antioxidant supplementation, and varicocele repair. The review also clarifies the guideline's public-health scope and delineates areas that remain within the domain of specialty practice. Finally, we discuss dissemination, implementation challenges, and research priorities, highlighting persistent evidence gaps in male reproductive biology, sperm function, and clinically meaningful treatment outcomes. By aligning public-health principles with contemporary understanding of male physiology, the WHO guideline provides a global foundation for equitable and systematic infertility care.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147345571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlation of Kidney Lenght and Body Parameters in CT Scans.","authors":"Ana Raquel M Morais, Carla M Gallo, Luciano A Favorito, Francisco J B Sampaio","doi":"10.1590/S1677-5538.IBJU.2026.9901","DOIUrl":"10.1590/S1677-5538.IBJU.2026.9901","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the renal length in patients submitted to computed tomography (CT scans) and compare it according to age, gender, laterality and body parameters like height, weight and Body Mass Index (BMI). Methods and Methods: We analyzed 74 patients (148 kidneys) submitted to CT scans and evaluated renal length in centimeters, gender, height, weight and BMI. The abdominal CT scans acquisition and image analysis was done using 16 and 64 slice multidetector computed tomography (MDCT) scanners to perform multiplanar reconstructions (MPR) and measure the kidney length (KL) in coronal plane. The statistical analysis was performed with the GraphPad Prism software (Version 9.2.0).</p><p><strong>Results: </strong>The 74 patients analyzed (28 Males/37.83% and 46 females/62.17%) presented mean age of 54.1 years-old, right kidney length between 8.4 to 13.1cm (mean=10.79) and left kidney length between 8.3 to 13.1cm (mean=10.97). The kidney length on both sides was significantly greater in male sex (p<0.001). The length of the left kidney was significantly greater than that of the right kidney (p=0.017). The linear regression analysis showed non-significant correlation between both right kidney length and positive correlations between kidney length and BMI, weight and height.</p><p><strong>Conclusions: </strong>CT scan accurately assessed renal length. We observed that renal length was greater in males and in the left side. Weight, age, height and body mass index showed a positive correlation with kidney length.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concomitant Bladder Neck Incision in Patients with Posterior Urethral Valve and Blad-der Neck Hypertrophy: Short-term Outcomes of a Randomized Controlled Trial.","authors":"Ahmed ELghareeb, Mohamed Dawaba, Mona Eldeeb, Abdelwahab Hashem, El-Husseiny I Ibrahim, Ahmed Abdelhalim","doi":"10.1590/S1677-5538.IBJU.2025.0539","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0539","url":null,"abstract":"<p><strong>Introduction: </strong>Concomitant bladder neck incision (BNI) with posterior urethral valve ablation (VA) was proposed to mitigate the long-term sequela of posterior urethral valve (PUV) and reduce the reoperation rates. This study aimed to investigate the short-term outcomes of concomitant BNI and VA, particularly short-term reoperation rates.</p><p><strong>Patients and methods: </strong>Patients with PUV and bladder neck hypertrophy on preoperative imaging were randomized to undergo VA only or VA with concomitant BNI. Surgical reoperation within one year was the primary endpoint. Renal function, UTI, hydronephrosis and VUR improvement at one year were secondary endpoints.</p><p><strong>Results: </strong>Sixty-three patients were included in the final analysis, 33 in VA group (group A) and 30 in concomitant BNI and VA group (group B). After one year of follow-up, the reoperation rate was similar [5(15.2%) in group A and 3(10%) in group B, p=0.18]. The median (IQR) nadir serum creatinine was lower in group B [0.2 (0.1-0.3) vs. 0.2 (0.2-0.4) mg/dL in group A, p=0.049]. The last follow-up serum creatinine median (IQR) eGFR [107 (89.5-163) in group A vs. 139(102-165) mL/min/1.73 m2 in groups B, p=0.37], and febrile UTI rates were not different between the two groups. Hydronephrosis improved/ resolved in 27 (40.9%) renal units in group A vs. 33 (55%) renal units in group B (p=0.286). Vesicoureteral reflux improved/ resolved in 23(34.8%) and 12 (20%) renal units in group A and B, respectively (p=0.074).</p><p><strong>Conclusion: </strong>Concomitant BNI with VA does not confer a lower short-term reoperation rate or better upper urinary tract outcomes compared to VA only.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147437017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safe to Spare? Predictors of Oncological Safety for Nerve-Sparing Technique during Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer. Insight from a High Volume Center with Centralized mpMRI Review.","authors":"Luca Lambertini, Fabrizio Di Maida, Giulia Carli, Antonio Andrea Grosso, Sofia Giudici, Anna Cadenar, Simone Sforza, Daniele Paganelli, Filippo Lipparini, Neliana Kucuku, Rossella Catanzaro, Francesca Conte, Francesco Lupo Conte, Matteo Salvi, Simone Agostini, Fausto De Nisco, Gabriella Nesi, Rino Oriti, Gianni Vittori, Andrea Minervini, Andrea Mari","doi":"10.1590/S1677-5538.IBJU.2025.0413","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0413","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate patterns and imaging-based predictors of positive surgical margins (PSMs) in patients with high-risk prostate cancer (PCa) undergoing nerve-sparing (NS) robot-assisted radical prostatectomy (RARP).</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 1,235 consecutive patients with high-risk PCa treated with RARP between 2022 and 2024 at a high-volume tertiary referral center. Among them, 533 patients underwent preoperative multiparametric MRI (mpMRI) reviewed by two expert uro-radiologists and MRI-ultrasound fusion biopsy. A per-side analysis was performed to identify predictors of ipsilateral PSMs in cases where neurovascular bundle (NVB) preservation was attempted. Biochemical recurrence (BCR) was assessed, and multivariable logistic regression was used to determine independent predictors of PSMs.</p><p><strong>Results: </strong>Overall, 36.1% of patients underwent non-nerve-sparing surgery, 49.5% unilateral NS, and 14.4% bilateral NS. Nerve sparing was performed on 418 surgical sides, with ipsilateral PSMs detected in 90 (21.5%). Sides with and without PSMs showed comparable nerve-sparing techniques (intra- vs interfascial) and similar 3-year BCR-free survival rates (68% vs. 69%) at a median follow-up of 36 months, although earlier biochemical failure at lower PSA thresholds was more frequent in PSM-positive sides. On multivariable analysis, larger prostate volume, apical tumor location, peripheral zone involvement, greater lesion diameter, and extracapsular extension on mpMRI were independently associated with an increased risk of ipsilateral PSMs.</p><p><strong>Conclusions: </strong>Nerve-sparing RARP may be feasible in carefully selected high-risk PCa patients. The integration of mpMRI-based predictors can enhance patient selection, optimizing the balance between oncologic safety and functional preservation. Prospective studies are warranted to validate these findings and minimize selection bias.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147356723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Salvage Single-Port Transvesical Robotic Radical Prostatectomy Following High-Intensity Focused Ultrasound (HIFU) Therapy.","authors":"Mohamad Watfa, Nicolas A Soputro, Abdulrahman Al-Bayati, Karim Daher, Salim Younis, Samarpit Rai, Rui M Bernardino, Lin Wang, Zeyad R Schwen, Ruben Olivares, Riccardo Autorino, Jihad Kaouk","doi":"10.1590/S1677-5538.IBJU.2025.0744","DOIUrl":"10.1590/S1677-5538.IBJU.2025.0744","url":null,"abstract":"<p><strong>Introduction: </strong>Focal therapy with high-intensity focused ultrasound (HIFU) has emerged as a treatment option for selected patients with localized prostate cancer; however, disease recurrence requiring salvage intervention remains a recognized challenge (1-5). Salvage radical prostatectomy is technically demanding due to post-ablative tissue changes, which may compromise oncologic and functional outcomes (6,7). Herein, we describe the surgical technique and clinical outcomes of salvage robotic-assisted radical prostatectomy (RARP) performed using a single-port (SP) transvesical approach following HIFU.</p><p><strong>Materials and methods: </strong>The index case was a 57-year-old man with a history of right hemigland HIFU for ISUP Grade Group 2 prostate cancer. During routine surveillance four years after HIFU, his PSA rose to 3.64 ng/mL, prompting repeat biopsy. Biopsy confirmed clinically significant recurrent prostate cancer both within and outside the prior treatment field, with bilateral involvement. Preoperatively, the patient reported satisfactory erectile function, with a Sexual Health Inventory for Men (SHIM) score of 25/25. After informed consent, salvage transvesical SP-RARP was performed. Dissection was carried out with anticipation of post-ablation tissue changes, and bilateral nerve-sparing was incorporated to optimize functional outcomes.</p><p><strong>Results: </strong>The procedure was completed in 82 minutes without placement of additional ports and without intraoperative complications. Estimated blood loss was 75 mL. The patient was discharged home the same day (4.3 hours postoperatively). Foley catheter removal on postoperative day 6 was followed by immediate urinary continence. Erectile function remained satisfactory at 3 months, indicating preservation of baseline functional outcomes. Final pathology demonstrated pT3b ISUP Grade Group 2 prostate cancer with evidence of prior ablation and negative surgical margins. At the most recent follow-up (12 months), PSA remained undetectable, with no biochemical recurrence.</p><p><strong>Conclusion: </strong>Transvesical SP-RARP appears to be a safe and effective salvage option following focal ablative therapy for prostate cancer. Leveraging the advantages of single-port robotic technology (8,9), this approach may facilitate outpatient surgery while maintaining favorable functional and oncologic outcomes.</p>","PeriodicalId":49283,"journal":{"name":"International Braz J Urol","volume":"52 3","pages":""},"PeriodicalIF":4.5,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13124183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}